| NPI | 1972956472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61023509) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA MD61023509) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2022-02-22 |